患有和未患有 COVID-19 的脓毒症重症患者的长期特征和预后

IF 3.2 3区医学 Q2 CRITICAL CARE MEDICINE Journal of critical care Pub Date : 2024-10-31 DOI:10.1016/j.jcrc.2024.154942

Felix Niebhagen , Lars Heubner , Anna Kirsch , Andreas Güldner , Hanns-Christoph Held , Ralph Schneider , Ulf Bodechtel , Jan Mehrholz , Thea Koch , Mario Menk , Peter Spieth

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引用次数: 0

摘要

背景患有 COVID-19 的脓毒症重症患者的院内死亡率明显高于未患 COVID-19 的患者。有关长期预后的知识仍然很少。在这项回顾性分析中，我们比较了有 COVID-19 和没有 COVID-19 的脓毒症重症患者的临床特征、长期功能预后和存活率。方法 2020 年至 2023 年期间，德累斯顿-克赖沙综合脓毒症中心（Comprehensive Sepsis Center Dresden-Kreischa registry）收集了没有 COVID-19 的脓毒症重症患者的数据。患有 COVID-19 的脓毒症重症患者的数据是在同一时期作为当地 ARDS/COVID-19 登记的一部分收集的。败血症诊断基于败血症-3定义。用于分析的变量来自电子健康记录。脓毒症确诊后 6-12 个月进行长期随访。生存率采用 Kaplan-Meier 曲线表示。结果372例脓毒症患者未携带COVID-19，301例患者携带COVID-19。患有COVID-19的脓毒症患者明显更年轻，Charlson综合指数明显更低，入ICU时的SOFA评分明显更高。长期随访显示，COVID-19 败血症患者的死亡率明显更高（73.4% 对 30.1%；HR 3.4 (95 % CI 2.73-4.27; p <0.05)）。COVID-19感染与死亡率显著增加（调整后 HR 3.27; 95 % CI 2.48-4.33; p <0.05）和健康相关生活质量下降（以 EQ-5D-3 L 指数衡量）（0.56 (0.16-0.79) vs. 0.79 (0.69-0.99); p <0.05）相关。此外，COVID-19 还是导致这些患者长期死亡率升高的一个独立风险因素。

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Long-term characteristics and outcomes of septic critically ill patients with and without COVID-19

Background

In-hospital mortality of septic critically ill patients with COVID-19 is significantly higher than in those without COVID-19. The knowledge on long-term outcomes remains scarce. In this retrospective analysis, we compare clinical characteristics, long-term functional outcomes, and survival in septic critically ill patients with and without COVID-19.

Methods

Data of septic critically ill patients without COVID-19 were collected as part of the Comprehensive Sepsis Center Dresden-Kreischa registry from 2020 to 2023. The data of septic critically ill patients with COVID-19 were collected as part of the local ARDS/COVID-19 registry over the same period. Diagnosis of sepsis was based on the Sepsis-3 definition. Variables collected for analyses were obtained from electronic health records. Long-term follow-up was performed 6–12 months after sepsis diagnosis. Survival was depicted using Kaplan-Meier curves. Associations between long-term mortality and risk factors were modeled by Cox Regression.

Results

372 septic patients without COVID-19 and 301 with COVID-19 were enrolled. Septic patients with COVID-19 were significantly younger, had a significantly lower Charlson Comorbidity Index, and had a significantly higher SOFA score at ICU admission. Long-term follow-up showed a significantly higher mortality in septic patients with COVID-19 (73.4 % vs. 30.1 %; HR 3.4 (95 % CI 2.73–4.27; p < 0.05)). COVID-19 infection was associated with significant increased mortality (adjusted HR 3.27; 95 % CI 2.48–4.33; p < 0.05) and reduced health-related quality of life, measured by the EQ-5D-3 L Index, (0.56 (0.16–0.79) vs. 0.79 (0.69–0.99); p < 0.05).

Conclusions

In our cohort of septic critically ill patients, health-related quality of life and long-term survival were considerably reduced in patients with concomitant COVID-19. Furthermore, COVID-19 could be identified as an independent risk factor for higher long-term mortality in these patients.

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来源期刊

Journal of critical care 医学-危重病医学

CiteScore

8.60

自引率

2.70%

发文量

237

审稿时长

23 days

期刊介绍： The Journal of Critical Care, the official publication of the World Federation of Societies of Intensive and Critical Care Medicine (WFSICCM), is a leading international, peer-reviewed journal providing original research, review articles, tutorials, and invited articles for physicians and allied health professionals involved in treating the critically ill. The Journal aims to improve patient care by furthering understanding of health systems research and its integration into clinical practice. The Journal will include articles which discuss: All aspects of health services research in critical care System based practice in anesthesiology, perioperative and critical care medicine The interface between anesthesiology, critical care medicine and pain Integrating intraoperative management in preparation for postoperative critical care management and recovery Optimizing patient management, i.e., exploring the interface between evidence-based principles or clinical insight into management and care of complex patients The team approach in the OR and ICU System-based research Medical ethics Technology in medicine Seminars discussing current, state of the art, and sometimes controversial topics in anesthesiology, critical care medicine, and professional education Residency Education.